Clinical trial of an air-circulating  cooling blanket for fever control in critically ill neurologic patients

Mayer, Stephan A.; Commichau, Christopher; Scarmeas, Nikolaos; Presciutti, Mary; Bates, J; Copeland, Dana D.

doi:10.1212/wnl.56.3.292

Cited by 87 publications

(37 citation statements)

References 29 publications

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“…Approximately 4 hours were required for cooling, while the mean body temperature during the first 48 hours of hypothermia was 33.2Ϯ1°C. Interestingly, Mayer et al 13 reported significantly poorer results, with a failure rate of 42%, using a combination of cooling blankets and acetaminophen for fever control. The preliminary results of the endovascular approach evaluated in our study are thus comparable to or slightly better than those obtained by external cooling, since the time required for hypothermia induction was 3Ϯ1 hours; approximately 15 additional minutes must be calculated for catheter insertion.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Cooling for Moderate Hypothermia in Patients With Acute Stroke: First Results of a Novel Approach

Georgiadis

Schwarz²,

Kollmar³

et al. 2001

Stroke

232

122

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Background and Purpose-We undertook this study to evaluate the feasibility of inducing and maintaining moderate hypothermia with the use of endovascular rather than surface cooling. Methods-Six patients with severe acute ischemic stroke were treated with moderate hypothermia. This was induced and maintained by circulating temperature-adjusted normal saline in a closed-loop system entailing 3 balloons located near the tip of a central line, which dwelled in the inferior vena cava. Results-The meanϮSD initial temperature of the patients was 37Ϯ1°C (range, 35.5°C to 38.4°C). The pace of cooling was 1.4Ϯ0.6°C/h , and target temperature was reached after 3Ϯ1 hours (range, 2 to 4.5 hours). During hypothermia, the maximal temperature observed was 33.4°C, and the minimal temperature was 32.2°C. Temperature deviations Ͼ0.2°C or Ͼ0.3°C were observed during 21% or 10% of the hours under hypothermia, respectively. Singultus was the only device-related complication encountered. Pulmonary infection, arterial hypotension, bradycardia, arrhythmia, and thrombocytopenia were the most common side effects. Key Words: stroke, acute Ⅲ stroke management T he neuroprotective properties of moderate hypothermia in acute ischemic stroke were demonstrated in several experimental models. The pathophysiological mechanisms involved include stabilization of the blood-brain barrier, 1-3 downregulation of cerebral metabolism, 4 and decrease of excitatory amino acids. 5,6 Additionally, preliminary clinical findings suggested that moderate hypothermia may influence mortality in patients with malignant middle cerebral artery infarction. 7,8 Currently, hypothermia is being induced by surface cooling with the use of cooling blankets, alcohol applied to exposed skin, or ice bags to groin, axilla, and neck. This approach, however, requires intensive effort from the medical and nursing staff for induction as well as maintenance of the target temperature. Conclusions-InductionRecently, an alternative approach based on intravenous cooling was proposed. A custom-built central line is advanced in the inferior vena cava. Normal saline is circulated through 3 balloons located near the tip of this line in a closed-loop system. Temperature regulation is achieved by adjusting the temperature of the circulating saline by a temperature-managing device.We undertook this study to evaluate the potential of intravenous cooling for induction as well as maintenance of moderate hypothermia (33°C). Subjects and MethodsA total of 6 patients (5 men and 1 woman aged 64.5Ϯ8.4 years) with an ischemic infarction involving at least two thirds of the territory of the left (nϭ5) or right (nϭ1) middle cerebral artery were treated with moderate hypothermia according to our institutional protocol. All patients were sedated with midazolam at the time of the study; fentanyl was used for analgesia and atracurium for neuromuscular blockade. Alpha-stat was used for acid-base management. Patients lay in the 30°head-up position and were ventilated with a volumecontrolled, pressure-regulated...

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Section: Discussionmentioning

confidence: 99%

Endovascular Cooling for Moderate Hypothermia in Patients With Acute Stroke: First Results of a Novel Approach

Georgiadis

Schwarz²,

Kollmar³

et al. 2001

Stroke

232

122

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“…However, in patients with neurologic injury, pregnancy or the pediatric population, treatment of fevers may be beneficial [34][35][36][37][38][39]. The SCIP, and this review, focuses on perioperative warming and maintenance of normothermia, current applications of hypothermia, and the detrimental effects associated with hypothermia during the perioperative period.…”

Section: The Importance Of Maintaining Normothermiamentioning

confidence: 99%

“…In patients with neurologic injury [34,[36][37][38], who are pregnant [37], or under the age of six [34,35,39], it may be beneficial to treat or prevent hyperthermia. When controllingfever, the goal is to eliminate the cause.…”

Section: Scip Measurement and Maintenance Of Normothermiamentioning

confidence: 99%

“…All other interventions should either be used in conjunction or until the source of the fever can be identified. Antipyretics may be used although they are rarely efficacious [34,36,38,84], especially if thermoregulatory centers have been damaged from a neurologic insult [38]. Cooling with a forced air device in the intensive care unit has been shown to be ineffective [38], however failure was attributed to intolerance from the patient, shivering, and vasoconstriction which all can be avoided with general anesthesia.…”

Section: Scip Measurement and Maintenance Of Normothermiamentioning

confidence: 99%

“…Antipyretics may be used although they are rarely efficacious [34,36,38,84], especially if thermoregulatory centers have been damaged from a neurologic insult [38]. Cooling with a forced air device in the intensive care unit has been shown to be ineffective [38], however failure was attributed to intolerance from the patient, shivering, and vasoconstriction which all can be avoided with general anesthesia. Other devices that have shown good efficacy in lowering body temperature include; water circulating gel-coated pads, water garments, intravascular devices, and infusion of cold intravenous fluids [7,31,34,36,79,83,[85][86][87].…”

Section: Scip Measurement and Maintenance Of Normothermiamentioning

confidence: 99%

See 2 more Smart Citations

Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

Sappenfield¹,

Hong²,

Galvagno³

2013

J Anesthesiol Clin Sci

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Intraoperative management of patient body temperature is a standard of care for practicing anesthesiologists. Merely complying with the Surgical Care Improvement Project (SCIP) measurement is inadequate for optimizing perioperative outcomes. Clinicians should have a sound understanding of available temperature monitoring sites, deleterious effects of hypothermia, and indications for therapeutic hypothermia. This foundation will help physicians use indicated modalities to improve patient outcomes throughout the perioperative period. The purpose of this paper is to review appropriate intraoperative temperature monitoring, the importance of maintaining normothermia, and indications for intraoperative hypothermia.

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Cooling therapy for acute stroke

Hertog

Worp

Tseng

et al. 2009

Cochrane Database of Systematic Reviews

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Trusted evidence. Informed decisions. Better health. Cochrane Database of Systematic Reviews REFERENCES References to studies included in this review Castillo 2003 {unpublished data only}Castillo J, Ortiz P, Ruiz J, Puerta JL. A randomized multicentre double blind clinical trial of metamizole 2g/8h, iv ampoules versus placebo every 8h iv ampoules, administered during 3 days consecutively as antithermic therapy in the acute phase of ischemic stroke. A 30 day study (ATIS study). Unpublished.

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Clinical trial of an air-circulating cooling blanket for fever control in critically ill neurologic patients

Abstract: Treatment with an air-circulating cooling blanket did not effectively reduce body temperature in febrile neuro-ICU patients treated with acetaminophen. More effective interventions are needed to maintain normothermia in patients at risk for fever-related brain damage.

Cited by 87 publications

References 29 publications

Endovascular Cooling for Moderate Hypothermia in Patients With Acute Stroke: First Results of a Novel Approach

Endovascular Cooling for Moderate Hypothermia in Patients With Acute Stroke: First Results of a Novel Approach

Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

Cooling therapy for acute stroke

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